Keiko Takase’s research while affiliated with Kanazawa University and other places

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Publications (11)


Survey of a Protocol to Increase Appropriate Implementation of Dispatcher-Assisted Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest
  • Article

February 2014

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75 Reads

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42 Citations

Circulation

Yoshio Tanaka

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Taiki Nishi

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Keiko Takase

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[...]

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Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) attempts to improve the management of out-of-hospital cardiac arrest (OHCA) by laypersons who are unable to recognize cardiac arrest and are unfamiliar with CPR. Therefore, we investigated the sensitivity and specificity of our new DA-CPR protocol for achieving implementation of bystander CPR in OHCA victims not already receiving bystander CPR. Since 2007, we have applied a new DA-CPR protocol that uses supplementary keywords. Fire departments prospectively collected baseline data regarding DA-CPR from January 2009 to December 2011. DA-CPR was attempted in 2747 patients; of these, 417 (15.2%) did not experience cardiac arrest. The sensitivity and specificity of the 2007 protocol vs. estimated values of the previous standard protocol were 72.9% vs. 50.3% and 99.6% vs. 99.8%, respectively. We identified keywords that may be useful for detecting OHCA. Multiple logistic regression analysis revealed that the occurrence of cardiac arrest after an emergency call (odds ratio = 16.85) and placing an emergency call away from the scene of the arrest (11.04) were potentially associated with failure to provide DA-CPR. Furthermore, at-home cardiac arrest (1.61) and family members as bystanders (1.55) were associated with bystander non-compliance with DA-CPR. No complications were reported in the 417 patients who received DA-CPR but did not have cardiac arrest. Our 2007 protocol is safe, highly specific, and may be more sensitive than the standard protocol. Understanding the factors associated with failure of bystanders to provide DA-CPR and implementing public education will be necessary to increase the benefit of DA-CPR.


Table 3 Differences between care facilities and other facilities in characteristics of OHCA patients
Placements of links in the "chain of survival" for care facilities and other facilities. The widths of circles represent an interquartile range (25-75%). The heights of circles denote the incidence. CPR cardiopulmonary resuscitation, EMT emergency medical technician, BLS basic life support, ACLS advanced cardiovascular life support.
Comparison of the outcome and incidence of VF/VT in relation to location.SROSC sustained return of spontaneous circulation. *Significantly different between care facilities and other public facilities (p < 0.05).
Misplaced links in the chain of survival due to an incorrect manual for the emergency call at public facilities
  • Article
  • Full-text available

September 2013

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67 Reads

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2 Citations

International Journal of Emergency Medicine

The incidence of delayed emergency calls and the outcome of out-of-hospital cardiac arrest (OHCA) may differ among public facilities when emergency calls are placed by institutional staff. The purpose of this study was to identify the actions prescribed in the rules and/or manuals of public facilities and to clarify whether the incidence of delayed emergency call placement and the outcome of OHCA differ among these facilities. We performed a questionnaire-based survey regarding emergency calls in public facilities in our community and analyzed our regional Utstein-based OHCA database. Our questionnaire survey disclosed that the most common actions prescribed in the manuals or rules applied in care facilities and educational institutions are to report the situation when a cardiac arrest occurs and to follow the directions of a custodian or supervisor. The international web search disclosed that these actions are rarely prescribed in medical emergency manuals in other countries. Most of these manuals simply say that staff should make an emergency call immediately upon detecting a serious illness or medical emergency. Analysis of the Utstein-based database from our community revealed that the time interval between collapse and emergency call placement is prolonged and the outcome of cardiac arrest poor in care facilities. A prompt emergency call and cardiopulmonary resuscitation (CPR) after arrest are associated with improved 1-year survival following OHCA. Contrary to accepted wisdom, staff who recognize a cardiac arrest may consult their supervisor and then continue CPR until they receive instructions from him or her. Manuals or rules for making emergency calls in our public facilities may contain incorrect information, and emergency calls may be delayed owing to correctable human factors. Such manuals should be checked and revised.

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Abstract 203: Potential Dependence on Type of Bystander Basic Life Support Response and Outcomes in Out-of-Hospital Cardiac Arrests Managed Without Any Involvement of Physicians

November 2012

Circulation

Objectives: The present study was conducted to test our hypothesis that relation of bystander to cardiac arrest victim may affect the BLAs response and outcomes in bystander-witnessed OHCAs. Methods: We obtained the Japanese nation-wide database for 547,218 OHCAs that occurred from Jan. 2005 to Dec. 2009, and extracted a dataset for 139,265 bystander-witnessed OHCAs without any involvement of physicians, that has all information for analysis. We first compared the BLS response of the four bystander groups (family members, friends and colleagues, passers-by and others). Then, we compared the outcomes of bystander-witnessed OHCAs having bystander CPR among the four groups. Results: The intervals between collapse and emergency call and between call and arrival at patient were shortest in OHCAs witnessed by pass-by. The telephone-CPR was most frequently attempted (45.8%, 41,442/90,426) but failed (39.4%, 16,315/41,442) in OHCAs witnessed by family. Consequently, the rate of bystander CPR was lowest (36.5%, 33,008/90,426), CPR was most frequently initiated following the telephone-CPR (76.1%, 25,127/33,008), and type of CPR was most frequently “chest-compression-only” (67.9%, 22,406/33,008) in OHCAs witnessed by family members. Multiple logistic regression analysis revealed that family as a type of bystander was an independent factor associated with lack of bystander CPR (Odds ratio=1.54 against passers-by, 2.09 against friends and colleagues, and 5.15 against others) . In all subcategories, the incidences of shockable initial rhythms and outcomes were lowest in the OHCAs witnessed by family members. Multiple logistic regression disclosed that that family member as a bystander group is one of the independent factor associated with 1-M unfavorable neurological outcomes in all subcategories of bystander-witnessed OHCAs. Conclusions: Family members do not quickly respond to OHCAs and unwilling to perform CPR on their own initiative. OHCAs witnessed by family and having bystander CPR have low incidences of shockable initial rhythm and 1-M favourable neurolofical survival. The first responder system that enable a good BLS performer to quickly reach the scene may be necessary in OHCAs witnessed by family.




Does the number of rescuers affect the survival rate from out-of-hospital cardiac arrests? Two or more rescuers are not always better than one

June 2012

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62 Reads

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27 Citations

Resuscitation

Review: An increased number of rescuers may improve the survival rate from out-of-hospital cardiac arrests (OHCAs). The majority of OHCAs occur at home and are handled by family members. Materials and methods: Data from 5078 OHCAs that were witnessed by citizens and unwitnessed by citizens or emergency medical technicians from January 2004 to March 2010 were prospectively collected. The number of rescuers was identified in 4338 OHCAs and was classified into two (single rescuer (N=2468) and multiple rescuers (N=1870)) or three (single rescuer, two rescuers (N=887) and three or more rescuers (N=983)) groups. The backgrounds, characteristics and outcomes of OHCAs were compared between the two groups and among the three groups. Results: When all OHCAs were collectively analysed, an increased number of rescuers was associated with better outcomes (one-year survival and one-year survival with favourable neurological outcomes were 3.1% and 1.9% for single rescuers, 4.1% and 2.0% for two rescuers, and 6.0% and 4.6% for three or more rescuers, respectively (p=0.0006 and p<0.0001)). A multiple logistic regression analysis showed that the presence of multiple rescuers is an independent factor that is associated with one-year survival (odds ratio (95% confidence interval): 1.539 (1.088-2.183)). When only OHCAs that occurred at home were analysed (N=2902), the OHCAs that were handled by multiple rescuers were associated with higher incidences of bystander CPR but were not associated with better outcomes. Conclusions: In summary, an increased number of rescuers improves the outcomes of OHCAs. However, this beneficial effect is absent in OHCAs that occur at home.


Don't stop your heart in front of your family: family as a bystander is associated with poor outcome of bystander-witnessed, bystander-CPR-performed out-of-hospital cardiac arrest

March 2012

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24 Reads

Critical Care

Early CPR with a considerable quality is essential for survival from out-of-hospital cardiac arrest (OHCA). This study was conducted to test our hypothesis that the relation of the bystander to the victim may affect the outcomes of OHCAs.



Abstract 227: The Effects of Obligatory Training on Attitudes Toward Performing Basic Life Support with Reference to Prior Training Experience

November 2011

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1 Read

Circulation

Backgrounds and aim The effects of BLS training on willingness to perform practicable actions in basic life support (BLS) have not been well studied. This study is conducted to determine the effects of an obligatory BLS training on attitude of the participants towards performing basic life support (BLS). Methods We gave a questionnaire to attendants of the courses for BLS in authorised driving schools. The questionnaire included questions about participants' backgrounds. The questionnaire explored the participant's willingness to perform BLS in four hypothetical scenarios related to early emergency call, CPR on their own initiative, telephone-assisted chest compressions and use of AED, respectively. The questionnaire survey was conducted in the two terms after revision of Japanese guidelines. The questionnaire was given at the beginning in the first term and at the end of course in the second term. Results (see Table) The BLS training augmented the proportions of willingness to use an AED and to perform favorable actions in all scenarios in all attendants with and without prior training, and the proportion to perform the CPR on their own initiative only in attendants without prior training. However, the training failed to increase the proportion of respondents willing to follow telephone-assisted instruction of chest compressions in all respondents with and without prior training. These observations were confirmed by multiple logistic regression analysis including backgrounds of attendants. Analysis of reasons for unwillingness and the actions that negative respondents answered to take suggested that obligatory training increases the confidence of their skill but augments a fear of misjudgment and reliance on other's judgment. Conclusions Obligatory BLS trainings and prior training experiences differently affect the attitude towards BLS. The training should be modified for attendants to gain the confidence of judgment in practical situations.


Citations (2)


... [1][2][3][4] In witnessed OHCA, patients who received bystander CPR had approximately twice the one-month survival rate compared to those who did not receive bystander CPR. 5 Bystanders who may not recognize cardiac arrest or have no prior CPR experience are encouraged to perform dispatcher-assisted CPR (DA-CPR), thereby increasing the chance of survival. [6][7][8][9] DA-CPR assists CPR by allowing the dispatcher to determine whether the patient is in cardiac arrest status and to provide instructions for chest compressions and ventilation or only chest compressions. 9,10 DA-CPR has a lower survival rate compared to public bystander-initiated CPR 9 ; this disparity in survival may be associated with the gender of those performing DA-CPR, 10 although this relationship has not been clearly examined. ...

Reference:

Impact of sex of bystanders who perform cardiopulmonary resuscitation on return of spontaneous circulation in out-of-hospital cardiac arrest patients: A retrospective, observational study
Survey of a Protocol to Increase Appropriate Implementation of Dispatcher-Assisted Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest
  • Citing Article
  • February 2014

Circulation

... Cardiopulmonary arrest (CPA) is one of the most common causes of death in middle and old age, with a high mortality rate even when patients receive appropriate treatment, including immediate cardiopulmonary resuscitation (CPR), defibrillation such as automated external defibrillation, and emergency medical services (EMS) [1][2][3][4]. The interval from patient collapse to defibrillation is recognized as a critical survival factor, significantly influencing favorable neurological outcomes in CPA patients [3,[5][6][7][8][9]. ...

Does the number of rescuers affect the survival rate from out-of-hospital cardiac arrests? Two or more rescuers are not always better than one
  • Citing Article
  • June 2012

Resuscitation